Friday, November 16, 2012

Weekly Overseas Health IT Links - 17th November, 2012.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

WASHINGTON – Medicare and Medicaidelectronic health record payments have surpassed $8 billion since its inception, with $8.36 billion paid out to 165,800 eligible physicians and hospitals in total program estimates through the end of October.

During October, CMS estimated that it paid Medicare eligible physicians and hospitals $435 million and Medicaid physicians and hospitals $210 million, for a total of $645 million, according to Robert Anthony, a specialist in CMS’ Office of eHealth Standards and Services. Hospitals accounted for $480 million.

The iPad continues to be a hugely popular but imperfect tool for physicians, as suggested by two papers presented Monday at the American Medical Informatics Association (AMIA) annual symposium in Chicago.

In two Fairview Health Services emergency departments in the Minneapolis-St. Paul area, physicians actually told IT leadership prior to the December 2010 go-live of an electronic medical record that they would not use the EMR unless they could access the new system on iPads. This “unique and interesting phenomenon,” as one of the newly published papers put it, prompted University of Minnesota researchers to explore why.

Several major academic medical centers have been fairly successful collecting electronic patient-reported data to help manage care and improve outcomes, but they still struggle to integrate the information with clinical information systems and physician workflow.

Such data can automate patient check in, assist with triage, lessen waiting time and get at health issues that might otherwise have gone unnoticed, presenters at the American Medical Informatics Association (AMIA) annual symposium said Sunday in Chicago. "The patient is the gold standard for reporting," said Dr. Deborah Miller, a social worker in the Mellen Center for Multiple Sclerosis Treatment and Research at the Cleveland Clinic, who moderated the session.

The day after President Obama was re-elected and Democrats held onto control of the U.S. Senate, the future looked bright to folks in the health IT field.

The election outcome suggested that attacks on the government's electronic health record incentive program by Congressional Republicans may lose steam or disappear altogether. Coincidentally, the Health IT Policy Committee met on Oct. 7 to discuss a draft of its Meaningful Use Stage 3 recommendations.

Robin Raiford, research director for the Meaningful Use practice of the Advisory Board Co., a healthcare consulting firm, listened in on the committee meeting, which was chaired by Farzad Mostashari, national coordinator of health IT. The tenor of the discussion, she told Information Week Healthcare, was that the committee would "move forward and finish the work that's been started."

Physicians are leaving private practice and seeking employment in large part due to the government's electronic health record requirements and related costs, which increase the overall cost of running a practice, according to a new report published by Accenture.

A majority of physicians surveyed (53 percent) specifically cited the EHR mandate as a primary reason for leaving private practice; 87 percent said that the overall cost and expense of running a business was the main concern influencing their decision to seek hospital employment instead.

Ease of use and the perceived advantage of logging on to personal health records were the leading factors to PHR adoption according to researchers from Brigham and Women's Hospital in Boston, who published their findings this week in the Journal of Medical Internet Research.

The study also looked at sociodemographic characteristics, access and use of technology, perceived innovativeness with technology, and perceptions of privacy and security.

In the study, 760 surveyed patients from the ambulatory care practices of Brigham and Women's Hospital and Massachusetts General Hospital were identified in three groups: PHR users; rejecters--those who never logged on; and non-adopters--those who initially logged on, but never used the PHR.

Moving from a desktop computer to an iPhone may seem like second nature to some – or like being attached to a ball and chain to others. As healthcare practices adopt and require mobile-based apps for their EMRs and other services, providers may find that they have little choice but to quit worrying and learn to love their mobile devices.

Brad Jannenga, CEO of WebPT, develops specialized software for physical therapy practices and entered the healthcare industry specifically because of a lack of good mobile based applications.

"In the medical space there's kind of a dichotomy," says Jannenga, who points out that incredibly advanced life-saving and life-sustaining technology has been developed that can "fit inside a briefcase." But "the software they're using to manage their practice" is so outdated that he likens it to the old green text on a black screen of the early command line based systems.

CHICAGO – Hospitals can have hundreds of IT systems. Vendors have built proprietary databases. Not everyone follows the same standards. Health systems fear sharing data with competitors. Policymakers have not focused on health information exchange or EHR usability.

These are just a few of the reasons why true interoperability of health information remains so elusive, according to a panel of informatics luminaries.

"Technology is only one obstacle to interoperability," said Gilad Kuperman, MD, director of interoperability informatics at New York-Presbyterian Hospital, who moderated the panel at the just-concluded American Medical Informatics Association (AMIA) Annual Symposium about why interoperability is "taking so darn long.

"Lung-on-a-chip" technology can mimic the life-threatening condition pulmonary edema and holds the potential to become an alternative to animal testing for drug toxicity, according to a new study in Science Translation Medicine.

Researchers at the Wyss Institute for Biologically Inspired Engineering at Harvard University introduced organ-mimicking chips two years ago, including the lung, heart, kidney and gut. A video of the "lung-on-a-chip" explains that within the thumb-sized device, a thin, porous membrane divides the space, with human lung cells exposed to air on one side and human capillary blood cells lining the other, with a medium flowing over them containing white blood cells. Vacuum chambers on the sides mimic the rhythmic expansion and contraction that occurs with breathing.

When Heidi Rehm surveys a patient’s genes and finds a variant she’s never seen before, she improvises. First Rehm, who directs a clinical genetics testing laboratory at Partners HealthCare in Cambridge, Massachusetts, checks through as many as ten databases to learn whether that variant has ever been associated with disease. Then she may ask colleagues at other clinical sequencing laboratories whether they have seen it. But the launch this week of a database known as ClinVar will make her job much easier — and allow her to ask more sophisticated questions.

Developed by the US National Institutes of Health (NIH) National Center for Biotechnology Information (NCBI) in Bethesda, Maryland, ClinVar integrates dozens of existing databases. It also provides, for the first time, a central place in which clinical testing laboratories can deposit their data, because most currently keep their data within the laboratory. By aggregating such information, ClinVar’s creators hope to accelerate clinicians’ understanding of the effects of variants as well as reveal whether different laboratories are interpreting the same variant in different ways.

Farzad Mostashari, MD, the national health IT coordinator, said that data and analytics played a critical role in the campaign and re-election of President Barack Obama – mirroring the growing importance of data in healthcare.

Data and analytics have transformed marketing, campaigning, and even baseball. “How is it possible for us to imagine a world where that power of data is not brought to bear on life and death, clinical care, on population health, and affirming the path that we are on with health IT and bringing data to life?” Mostashari said in comments about his thoughts the morning after the election at the Nov. 7 meeting of the federal advisory Health IT Policy Committee.

Cheryl Clark, for HealthLeaders Media , November 7, 2012

Healthcare leaders should be on special alert for three serious hazards that increasingly threaten both patients and providers with harm, says the ECRI Institute's Top 10 Health Technology Hazards report for 2013.

The three hazards involve electronic health records, health information technology systems, and cell phones and other mobile devices, which can distract healthcare providers from the focus they need for tasks at hand many times an hour.

As healthcare organizations gain experience with IT systems, they’re encountering ways in which technology can introduce mistakes with far-reaching consequences. For example, simple errors may result in one patient's test results or prescription orders finding their way into another patient's medical record.

Electronic health records (EHRs) are essential to improving patient safety.1 Hospitals and health care providers are implementing EHRs rapidly in response to the American Recovery and Reinvestment Act of 2009. 2-4 The number of certified EHR vendors in the United States has increased from 60 5,6 to more than 10007 since mid-2008. Recent evidence has highlighted substantial and often unexpected risks resulting from the use of EHRs and other forms of health information technology. 8-12 These concerns are compounded by the extraordinary pace of EHR development and implementation. Thus, the unique safety risks posed by the use of EHRs should be considered alongside the potential benefits of these systems.

There's nothing like a common enemy or problem to bring people together. In the days since Hurricane Sandy, we've witnessed countless acts of heroism and generosity in the face of destruction and despair. It's a pity Americans can't bring that same sense of common purpose to health information exchanges.

Many would argue that the immediate threat and aftermath of a storm far outweigh the negative consequences of a poor system for sharing patient data. But that's an illusion. Some 50 people died in Hurricane Sandy, but more patients die each day as a result of poor communication among clinicians and inadequate exchange of data during transitions from hospitals to nursing homes and rehab facilities.

Scott Mace, for HealthLeaders Media , November 6, 2012

When a CIO I spoke with recently stated that Twitter scared him, I doubled my efforts to seek out a good story about use of social media by a healthcare provider. Within a couple of weeks, I found four.

Timimi, a cardiologist and the medical director for the Mayo Clinic Center for Social Media, uses social media strategically. Speaking at the annual meeting of the Association of American Medical Colleges in San Francisco, Farris Timimi, MD, he made those strategies come alive.

The first story involved Philip R. Fischer, MD, a Mayo physician and expert on Postural Orthostatic Tachycardia Syndrome (POTS). Fischer's administrative partner, Lee Aase, made a 22-minute video of Fischer speaking about POTS.

Use of an electronic health record clinical decision support system to prescribe antibiotics for patients suffering from acute respiratory infections helps to ensure the appropriateness of those prescriptions, a study recently published online in the Journal of General Internal Medicine concludes.

For the study, nine primary care practices within the Practice Partner Research Network (PPRNet)--a practice-based research organization based at the Medical University of South Carolina in Charleston--participated in a two-phase, 27-month long demonstration pilot in which the practices used a common EHR CDSS that targeted multiple factors. The researchers found that use of broad spectrum antibiotics for acute respiratory infections--sinusitis, in particular--declined by slightly more than 16 percent for both adults and children.

Whether it's due to skepticism or a lack of resources, not all doctors are sold on the prospects of mHealth. But for those looking to stick their toe into the pool, tablets are finding widespread adoption as a good entry point for clinics and doctor's offices.

Recent surveys have indicated roughly 80 percent of doctors use mobile devices, and between 40 percent and 50 percent are using tablets. With new tablets coming out almost every week, and surveys indicating almost 80 percent of consumers want to see their doctors using mobile health solutions, clinicians are turning to tablets for that most basic of functions: Patient registration.

While many early accounts of last night’s party for President Obama hail the news as a boon for the Affordable Care Act (ACA), once that excitement wears off, Americans will realize that it's just too early to tell whether the reelection will actually be fertilizer or formaldehyde for health reform and for what to date has been viewed as bipartisan support for health IT.

Yes, the law remains just that: legislation that passed, survived a Supreme Court challenge and, as of today, is safe from GOP contender Mitt Romney’s campaign promises to repeal it entirely.

Physicians who don’t manage their online presence run the risk of failing to attract new patients.

A majority of Americans looking up health information online are no longer merely researching symptoms. They are going online to determine which physicians to see, what treatment to get, and what services a hospital or pharmacy might provide — and using that information to drive their choices.

According to Manhattan Research, which surveyed 5,210 adults who use the Internet as a health resource, 54% of respondents said they did online research to decide what services they might need and who should provide them. Various surveys have said that roughly 75% of American adults search for health information online.

With the support of health information technology, astute preparation by staff and, yes, even a little good old-fashioned luck,some hospitals and health systems along Hurricane Sandy’s path emerged from the storm relatively unscathed.

Officials at Atlanticare, one of New Jersey’s largest healthcare systems, based in Galloway and Atlantic City, N.J., cite early preparation among IT and safety staff as key to surviving this kind of storm.

“I had actually been tracking the weather the week prior,” Debra Fox, chief safety office at Atlanticare, tells Healthcare IT News. “Thursday is actually when we initiated our planning and communication to the leadership around beginning to put their operational preparedness plans in place,” she adds. This included topping off generator fuel and ensuring that the facility is able to withstand a loss of power.

CHICAGO – Regenstrief Institute was a pioneer in clinical decision support, but its system was aging. Most noticeably, the interface in its famed "Gopher" computerized physician order entry system looked the same in 2010 as it did in 1984.

After two years of redesign, the venerable Indianapolis institution unveiled an update last year with more than just a modern look, Regenstrief researchers pointed out Monday at the annual American Medical Informatics Association (AMIA) symposium.

As interoperability issues persist in the health information exchange market, respondents in a new KLAS survey report dissatisfaction with their vendors.

"Building and supporting interfaces continues to be a big challenge for all vendors," report author Mark Allphin said in an announcement. "Providers expect their health information exchange vendor to be an expert in moving data between multiple EMRs--regardless of the complexities or costs."

"While many health IT implementations offer great promise for improving patient care, it must be recognized that these complex technologies also can create new paths to failure," the report states, urging healthcare facilities to pay particular attention to health IT when prioritizing their safety initiatives for 2013.

PLYMOUTH MEETING, PA – Health IT may promise a new paradigm of patient care, but it's also fraught with complexity and the potential for error. A new report from ECRI Institute, which researches best practices to improve care delivery, outlines the top 10 health technology hazards for 2013, and health IT systems are disconcertingly close to the top.

ECRI's 6th annual “Top 10 Health Technology Hazards list” is designed to raise awareness of the potential dangers associated with the use of medical devices and systems. A popular roadmap for healthcare providers to prioritize their technology safety initiatives, the list features key topics that warrant particular attention for the coming year with actionable recommendations on addressing them.

An international nonprofit is launching a publicly accessible database of medical registries it hopes will better track outcomes -- and through that improve quality -- for some of the most burdensome conditions.

"What we're trying to do is enable best practices sharing by comparing outcomes for either diseases or procedures in a structured format," Peter Lawyer, senior partner and managing director with the Boston Consulting Group (BCG), told MedPage Today.

Managing patient identities is one of the hidden problems of health information exchange (HIE) and electronic health record (EHR) technology. While every patient needs a single, unique identifier tied to his medical records and billing information, a simple typo or a misspoken birthday can leave a patient with duplicate records, potentially compromising his care. Many hospitals use their own master patient indexes (MPIs) to check if patients have an existing record, but the emergence of HIE means new challenges in ensuring accuracy across multiple providers for millions of new patients.

Beth Just, MBA, RHIA, FHIMA, and president and CEO of Just Associates, Inc., tells For the Record that an MPI involves “all of the patient’s identifying information, such as names, birth dates, Social Security numbers, addresses, and phone numbers, [being] stored in a central data table.” But unique identifiers must be the same across the entire HIE for the network to function, which can be accomplished with the help of a system-wide enterprise MPI (EMPI). An EMPI provides its own identifier that spans the entire network, requiring accurate and complete data across every department or healthcare provider contributing to a patient’s care.

A couple of months ago, I completed a master trainer course offered by the Agency for Healthcare Research and Quality on TeamSTEPPS, a set of evidence-based strategies and tools to enhance team performance and patient safety. Information sharing and communication are key principles of the program. Since the training, I have thought about opportunities to leverage emerging technologies, including interactive websites, social media, Web-based video conferencing, mobile and more into health care.

About TeamSTEPPS

TeamSTEPPS promotes techniques that create highly effective medical teams that optimize the use of information, people and resources to achieve the best clinical outcomes for patients and eliminate barriers to safety. These techniques include Briefs, Huddles and Debriefs, Check-backs or Teach-backs, Feedback, Advocacy and Assertion and SBAR (Situation, Background, Assessment, Recommendation). While the system originally was focused on the professional care team, the techniques also can be applied to communications and engagement of patients and family caregivers; especially during transitions in care.

Computational models are increasingly helping healthcare researchers to understand how to both identify and treat complex diseases, according to a recent article published by four Johns Hopkins professors in the journal Science Translational Medicine. The professors cite several examples of how computational models have improved research efforts for diseases such as Alzheimer's, as well as how they are being used for preventive care.

"The field has exploded. There is a whole new community of people being trained in mathematics, computer science and engineering, and they are being cross-trained in biology," Raimond Winslow, director of the school's Institute for Computational Medicine and co-author of the article, said in a statement.

Hospitals nationwide are turning to informatics to streamline care processes, improving both the efficiency and safety of patient care. One facility that appears to be ahead of the curve, however, is Children's Hospital Boston, which, according to CIO Dan Nigrin saves roughly $1.4 million annually by using informatics in its medication delivery system.

"The pharmacy is made aware of changes much more expeditiously than when we were paper based," Nigrin told FierceHealthIT in an exclusive interview. "The pharmacy has gotten to essentially be much more of a just-in-time delivery model, where they're continuously delivering medications to the floor, every hour or every two hours, as opposed to every 12. If a medication has changed, the amount of potential waste that occurs because the medication was, for instance, discontinued, has dropped dramatically."

The Health Information Trust Alliance offered its support for an effort by Sen. Jay Rockefeller (D-W.Va.) to raise awareness of what both call a growing cybersecurity threat.

In a three-page letter to Rockefeller, HITrust CEO Daniel Nutkis said the organization "applauds lawmakers' and regulators' attention to this issue and is supportive of anything that protects national critical infrastructure and avoids disruptions or losses that can be caused by cyberattacks."

Thus, HITrust backs Rockefeller's call for the business community to work with government to address the issue, with the caveat that lawmakers and government officials take into account the public-private collaborations already in place, "learn from what is working, and minimize new burdensome assessments and audits that will divert resources from the real task of enhancing cyber threat detection and response capabilities."

Electronic record systems are among the most important healthcare advances of our times.

They bring better, more sustainable healthcare and offer the NHS the opportunity to make large savings – allowing more public money to be invested in improving patient outcomes.

However, a recent survey of more than 1,000 UK citizens revealed that 86.5% of respondents believed a serious breach of personal data would do considerable damage to a hospital's reputation, while 87.2% thought the NHS should monitor who looks at their patient records.